Osteomyelitis Osteomyelitis Classification & resources ICD-10 ICD-9

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M86. 730

DiseasesDB 9367 MedlinePlu 000437 s eMedicine MeSH ped/1677 C01.539.160. 495

Osteomyelitis is an infection of bone or bone marrow, s ally ca sed by pyo!enic bacteria or mycobacteria. "t can be sef lly s bclassified on t#e basis of t#e ca sati$e or!anism, t#e ro te, d ration and anatomic location of t#e infection. %ontents

1 ' 3 4 * 6

&resentation (tiolo!y )reatment %a ses +ee also ,eferences

&resentation -enerally microor!anisms may be disseminated to bone #emato!eno sly . i.e., $ia t#e blood stream/, spread conti! o sly to bone from local areas of infection, s c# as cell litis, or be introd ced by penetratin! tra ma incl din!iatro!enic ca ses s c# as 0oint replacements, internal fi1ation of fract res or root2canalled teet#. 3e 4ocytes t#en enter t#e infected area, and in t#eir attempt to en! lf t#e infectio s or!anisms, release en5ymes t#at lyse bone. & sspreads into t#e bone6s blood $essels, impairin! t#e flow, and areas of de$itali5ed infected bone, 4nown as sequestra, form t#e basis of a c#ronic infection. Often, t#e body will try to create new bone aro nd t#e area of necrosis. )#e res ltin! new bone is often called an in$ol cr m. On #istolo!ic e1amination, t#ese areas of necrotic bone are t#e basis for distin! is#in! between acute osteomyelitis and chronic osteomyelitis. Osteomyelitis is an infecti$e process w#ic# encompasses all of t#e bone .osseo s/ components, incl din! t#e bone marrow. 7#en it is c#ronic it can lead to bone sclerosis and deformity. 8eca se of t#e partic lars of t#eir blood s pply, t#e tibia,

t#efem r, t#e # mer s, t#e $ertebra, t#e ma1illa and t#e mandib lar bodies are especially s sceptible to osteomyelitis.91: (tiolo!y Age group Most common organisms ;ewborns .yo n!er t#an S aureus, Enterobacter species, and !ro p < and 4 mo/ 8 Stre tococcus species %#ildren .a!ed 4 mo to 4 S aureus, !ro p < Stre tococcus species, !aemo hilus y/ influen"ae, and Enterobacter species %#ildren, adolescents S aureus .80=/, !ro p < Stre tococcus species, ! influen"ae, .a!ed 4 y to ad lt/ and Enterobacter species S aureus and <d lt occasionally Enterobacter or Stre tococcus species "n c#ildren, t#e lon! bones are are most commonly affected. s ally affected. "n ad lts, t#e $ertebrae and t#e pel$is

<c te osteomyelitis almost in$ariably occ rs in c#ildren. 7#en ad lts are affected, it may be beca se of compromised #ost resistance d e to debilitation, intra$eno s dr ! ab se, infectio s root2canalled teet#, ot#er disease or dr !s .e.!. imm nos ppressi$e t#erapy/. )reatment Osteomyelitis often re> ires prolon!ed antibiotic t#erapy. "? antibiotics are !enerally sed to combat t#e infection, wit# a co rse lastin! a matter of wee4s or mont#s. < &"%% line or central $eno s cat#eter is often placed for t#is p rpose. Osteomyelitis also may re> ire s r!ical debridement. +e$ere cases may lead to t#e loss of a limb. "nitial first line antibiotic c#oice is determined by t#e patient6s #istory and re!ional differences in common infecti$e or!anisms. <merican artist )#omas (a4ins in 187* depicted a s r!ical proced re for osteomyelitis in a famo s oil paintin! titled @)#e -ross %linic,@ now part of Aefferson Medical %olle!e. &rior to t#e widespread a$ailability and se of antibiotics, blow fly lar$ae were sometimes deliberately introd ced to t#e wo nds to feed on t#e infected material, effecti$ely sco rin! clean. 9': %a ses Sta hylococcus aureus is t#e or!anism most commonly isolated from all forms of osteomyelitis. Bemato!eno sly seeded osteomyelitis is seen most fre> ently in c#ildren, and nearly 90= of cases are ca sed by Sta hylococcus aureus. "n infants, S. aureus, -ro p 8

streptococci and Escherichia coli are commonly isolatedC in c#ildren from 1 to 16 years of a!e, S. aureus, Stre tococcus yo#enes, and !aemo hilus influen"ae are common. "n some s bpop lations, incl din! intra$eno s dr ! sers and splenectomi5ed patients, -ram ne!ati$e bacteria, incl din! enteric bacilli, are si!nificant pat#o!ens.93: )#e most common form of t#e disease in ad lts is ca sed by in0 ry e1posin! t#e bone to local infection.Sta hylococcus aureus is a!ain t#e most common or!anism seen in osteomyelitis seeded from areas of conti! o s infection, b t anaerobes and -ram ne!ati$e or!anisms, incl din! $seu%omonas aeru#inosa, E. coli, and Serratia marcescens, are also common, and mi1ed infections are t#e r le rat#er t#an t#e e1ception.93: +ystemic mycotic .f n!al/ infections may also ca se osteomyelitis. )#e two most common are 8lastomyces dermatitidis and %occidioides immitis. "n osteomyelitis in$ol$in! t#e $ertebral bodies, abo t #alf t#e cases are d e to Sta hylococcus aureus, and t#e ot#er #alf are d e to t berc losis .spread #emato!eno sly from t#e l n!s/. ) berc lar osteomyelitis of t#e spine was so common before t#e initiation of effecti$e antit berc lar t#erapy t#at it ac> ired a special name, $ott&s %isease, by w#ic# it is sometimes still 4nown.
+ee also 1. 8rodie abscess ,eferences Din! ME, ,andall 7.C Ea$id Ao#nson, ME, F<%(& .'006207213/. Osteomyelitis. e'e%icine. 7ebME. ,etrie$ed on '007211211. '. 8aer M.E., 7illiam +. .1931/. @)#e )reatment of %#ronic Osteomyelitis wit# t#e Ma!!ot .3ar$a of t#e 8low Fly/@. (ournal of )one an% (oint Sur#ery 1!G 438247*. ,etrie$ed on '00721121'. 3. H a b %are4 &A, Eic4erson 3M, +ac4 A3. @Eia!nosis and mana!ement of osteomyelitis.@ <m Fam &#ysician. '001 A n 1*C63.1'/G'4132'0. 5*54b. at Merc4 Man al of Eia!nosis and )#erapy &rofessional (dition 00+9, at %BO,I+ $JdJe

Diseases o" t#e musculos$eletal system and connecti%e tissue &M' (10(!9) <rt#ritis .+eptic art#ritis, ,eacti$e art#ritis, ,#e matoid art#ritis, &soriatic art#ritis, Felty6s syndrome, A $enile idiopat#ic art#ritis, +till6s disease/ 2 crystal .-o t,%#ondrocalcinosis/ 2 Osteoart#ritis .Beberden6s node, 8o c#ard6s nodes/ Art#ropat#ies

acquire% %eformities of fin#ers an% toes .8o tonniere deformity, 8 nion, Ball 1 ri!id s, Ball 1 $ar s, Bammer toe/ 2 other acquire% %eformities of limbs .?al! s deformity, ?ar s deformity, 7rist drop, Foot drop, Flat

feet, %l b foot, Ine> al le! len!t#, 7in!ed scap la/

atella .3 1atin! patella, %#ondromalacia patellae/ &rotr sio acetab li 2 Bemart#rosis 2 <rt#ral!ia 2 Osteop#yte &olyarteritis nodosa 2 %# r!2+tra ss syndrome 2 Dawasa4i disease 2 Bypersensiti$ity $asc litis 2 -oodpast re6s syndrome 2 7e!ener6s !ran lomatosis 2 <rteritis .)a4ayas 6s arteritis, )emporal arteritis/ 2 Microscopic polyan!iitis 2 +ystemic l p s eryt#ematos s .Er !2ind ced/ 2 Eermatomyositis .A $enile dermatomyositis/ 2&olymyositis 2 +cleroderma 2 +0K!ren6s syndrome 2 8e#Let6s disease 2 &olymyal!ia r#e matica 2 (osinop#ilic fasciitis 2 Bypermobility Dyp#osis 2 3ordosis 2 +coliosis 2 +c#e ermann6s disease 2 +pondylolysis 2 )orticollis 2 +pondylolist#esis 2 + pondylopat#ies .<n4ylosin! spondylitis, +pondylosis, +pinal stenosis/ 2 +c#morl6s nodes 2 Ee!enerati$e disc disease 2 %occydynia 2 8ac4 pain .,adic lopat#y, ;ec4 pain, +ciatica, 3ow bac4 pain/ muscle- Myositis 2 Myositis ossificans .Fibrodysplasia ossificans pro!ressi$a/ syno.ium an% ten%on- +yno$itis .+tenosin! tenosyno$itis, )ri!!er syndrome/ 2 )enosyno$itis fin!er, EeM er$ain6s

Systemic connect i%e tissue disorders

Dorsopat#ies

bursitis .Olecranon, &repatellar, )roc#anteric/ fibroblastic .E p ytren6s fasciitis, ;od lar fasciitis, Fasciitis, Fibromatosis/ contract re, &lantar fasciitis, ;ecroti5in!

So"t disorders

tissue

entheso athies ."liotibial band syndrome, <c#illes tendinitis, &atellar tendinitis, -olfer6s elbow, )ennis elbow, Metatarsal!ia, 8one sp r, )endinitis/ other/ 0EC- M scle wea4ness 2 ,#e matism 2 Myal!ia 2 ;e ral!ia 2 ;e ritis 2 &annic litis 2 Fibromyal!ia %isor%ers of bone %ensity an% structure- Osteoporosis 2 Osteomalacia 2 continuity of bone .&se dart#rosis, +tress fract re/ 2 Monostotic fibro s dysplasia 2 +4eletal fl orosis 2 <ne rysmal bone cyst 2 Byperostosis 2 Osteosclerosis Osteomyelitis 2 <$asc lar necrosis 2 &a!et6s disease of

Osteopat#ies

bone 2 <l!one rodystrop#y 2 Osteolysis 2 "nfantile cortical #yperostosis (u.enile osteochon%rosis .3e!!2%al$N2&ert#es syndrome, Os!ood2+c#latter disease, DK#ler C#ondropat#ies disease, +e$er6s disease/ 2 Osteoc#ondritis 2 )iet5e6s syndrome See also con#enital con%itions 1265*239/ 354*3564 Osteomyelitis Osteomyelitis is a bone infection ca sed by bacteria or ot#er !erms. Causes 8one infection is most often ca sed by bacteria, b t it can also be ca sed by f n!i or ot#er !erms.

8acteria may spread to a bone from infected s4in, m scles, or tendons ne1t to t#e bone. )#is may occ r nder a s4in sore. )#e infection can also start in anot#er part of t#e body and spread to t#e bone t#ro !# t#e blood. < bone infection can also start after bone s r!ery. )#is problem is more li4ely if t#e s r!ery is done after an in0 ry or if metal rods or plates are placed in t#e bone.

"n c#ildren, t#e lon! bones of t#e arms or le!s are most often in$ol$ed. "n ad lts, t#e feet, spine bones .$ertebrae/, and #ips .pel$is/ are most commonly affected. ,is4 factors areG

Eiabetes Bemodialysis &oor blood s pply ,ecent in0 ry Ise of ille!al in0ected dr !s

&eople w#o #a$e #ad t#eir spleen remo$ed are also at #i!#er ris4 for osteomyelitis. Symptoms

8one pain Fe$er -eneral discomfort, neasiness, or ill2feelin! .malaise/ 3ocal swellin!, redness, and warmt#

Ot#er symptoms t#at may occ r wit# t#is diseaseG

%#ills (1cessi$e sweatin! 3ow bac4 pain +wellin! of t#e an4les, feet, and le!s

*+ams and ,ests < p#ysical e1am s#ows bone tenderness and possibly swellin! and redness. )ests may incl deG

8lood c lt res 8one biopsy .w#ic# is t#en c lt red/ 8one scan 8one 12ray %omplete blood co nt .%8%/ %2reacti$e protein .%,&/ (ryt#rocyte sedimentation rate .(+,/ M," of t#e bone ;eedle aspiration of t#e area aro nd affected bones

,reatment )#e !oal of treatment is to !et rid of t#e infection and red ce dama!e to t#e bone and s rro ndin! tiss es. <ntibiotics are !i$en to destroy t#e bacteria ca sin! t#e infection.

Oo may recei$e more t#an one antibiotic at a time. Often, t#e antibiotics are !i$en t#ro !# an "? .intra$eno sly, meanin! t#ro !# a $ein/ rat#er t#an by mo t#. <ntibiotics are ta4en for at least 4 2 6 wee4s, often t#ro !# an "? at #ome.

+ r!ery may be needed to remo$e dead bone tiss e if yo #a$e an infection t#at does not !o away.

"f t#ere are metal plates near t#e infection, t#ey may need to be remo$ed. )#e open space left by t#e remo$ed bone tiss e may be filled wit# bone !raft or pac4in! material. Eoin! t#is promotes t#e !rowt# of new bone tiss e.

"nfection t#at occ rs after 0oint replacement may need s r!ery to remo$e t#e replaced 0oint and infected tiss e aro nd t#e area. < new prost#esis may be implanted in t#e same operation. More often, doctors wait ntil t#e infection #as !one away. "f yo #a$e diabetes, it will need to be well controlled. "f t#ere are problems wit# blood s pply to t#e infected area, s c# as t#e foot, s r!ery to impro$e blood flow may be needed to treat t#e infection. Outloo$ &Prognosis) 7it# treatment, t#e o tcome for ac te osteomyelitis is s ally !ood. )#e o tloo4 is worse for t#ose wit# lon!2term .c#ronic/ osteomyelitis. +ymptoms may come and !o for years, e$en wit# s r!ery. <mp tation may be needed, especially in t#ose wit# diabetes or poor blood circ lation. )#e o tloo4 for t#ose wit# an infection of t#e prost#esis depends, in part, onG

)#e patient6s #ealt# )#e type of infection 7#et#er t#e infected prost#esis can be safely remo$ed

-#en to Contact a Medical Pro"essional %all yo r #ealt# care pro$ider ifG

Oo de$elop symptoms of osteomyelitis Oo #a$e osteomyelitis and t#e symptoms contin e despite treatment

.e"erences Matteson (3, Osmon E,. "nfections of b rsae, 0oints, and bones. "nG -oldman 3, +c#afer <", eds. Cecil 'e%icine. '4t# ed. &#iladelp#ia, &aG +a nders (lse$ierC '011Gc#ap '80. 8erbari 8F, +tec4elber! AM, Osmon Er. Osteomyelitis. "nG Mandell -3, 8ennett A(, Eolin ,, eds. $rinci les an% $ractice of 5nfectious 6iseases. 7t# ed. &#iladelp#ia, &aG (lse$ier %# rc#ill 3i$in!stoneC '009Gc#ap 103